Carlos E. Jiménez

SPECT imaging in a patient with monostotic rib fibrous dysplasia

A 24-year-old man was noted to have a right pleural based mass on his chest radiographs. A Tc-99m HDP bone scan was ordered to evaluate the extent of the disease and to select appropriate sites of biopsy. Delayed planar and SPECT images demonstrated an area of Increased uptake involving the right seventh rib lateral area. The differential diagnosis included sarcoma, lymphoma, enchondroma, fibrous dysplasia, bone cyst, or an infectious process. The patient had a biopsy-proven fibrous dysplastic lesion. Fibrous dysplasia is a benign bony neoplasm In which the osteoblasts fail to differentiate normally. Although any bone may be involved, it frequently occurs in only one bone (monostotic). Typical sites of involvement Include the skull, femur, tibia, and humerus.

A Soldier's Neck and Shoulder Pain.

A 38-year-old male soldier presented to an acute care clinic complaining of 24 hours of persistent, bilateral shoulder and neck pain after a 12-mile road march. He denied any history of prior trauma to either area. On physical examination, there was diffuse tenderness in both supraclavicular areas as well as over the posterior neck.

Preparing Active Patients for International Travel

The risk of acquiring an illness when traveling internationally depends mostly on the area of the world to be visited. Today, with so many transportation options, increasing numbers of athletes are traveling abroad for training and competition, and leisure travelers are enjoying physically challenging adventure vacations-thus exposing themselves to potential medical problems. Primary care, sports medicine, and team physicians must be able to provide travelers with up-to-date information on immunization and chemoprophylaxis requirements, as well as other preventive medicine recommendations.

Ectopic laryngeal parathyroid adenoma detected by SPECT sestamibi imaging

A 68-year-old woman presented with elevated serum calcium and elevated parathyroid hormone (PTH). Planar Tc-99m sestamibi imaging revealed an ectopic localization of radiopharmaceutical uptake in the neck to the left of the midline. Two surgical attempts failed to identify the parathyroid adenoma. SPECT Tc-99m sestamibi imaging revealed the location of the parathyroid adenoma near the midline of the neck in an anterior location. Angiography of the neck demonstrated a possible vascular mass in the larynx. Laryngoscopy while the patient was under general endotracheal anesthesia revealed a pedicled mass in the hypopharynx under the left arytenoid in the region of the left piriform sinus. After excision of this mass, the patient became normocalcemic. Pathologic examination of the excised tissue confirmed it was a parathyroid adenoma.

Insidious Illness in Active Seniors

Older athletes and active seniors may have serious medical problems without commonly recognized signs and symptoms. The cases of an older tennis player, a golfer, and a deep-sea sport fisherman illustrate unusual presentations of coronary artery disease, bacterial pneumonia, and peptic ulcer disease in senior patients. Alertness for the effects of coexisting illnesses, chronic use of medicines, reduced physiologic and immunologic reserves, altered pain perception, and symptom denial can facilitate prompt treatment of active senior patients.

The Colyte renal scan.

Fecal impaction is a rare cause of urinary tract obstruction that is reversible with removal of the stool. In this 7-year-old girl with bilateral duplicated collecting systems, non-neurogenic bladder (Hinman syndrome) and encopresis, the initial furosemide renal scintigraphic examination showed an obstructed left lower moiety. Because of this unusual pattern of obstruction in a duplicated system along with radiographic evidence of massive fecal impaction, a repeated furosemide renal study performed after aggressive Colyte bowel cleansing showed resolution of the left lower moiety obstruction. The authors believe theirs is the first reported case of fecal impaction causing urinary tract obstruction in Hinman syndrome demonstrated on renal furosemide scintigraphy.

Detection of distant medullary thyroid carcinoma metastases by Tc-99m arcitumomab scintigraphy.

A 54-year-old woman with a history of medullary thyroid carcinoma after total thyroidectomy in 1992 was examined and found to have increasing serum carcinoembryonic antigen and calcitonin levels. Imaging with Tc-99m DMSA, neck and mediastinal MRI, and In-111 octreotide failed to reveal any recurrence or metastasis. Tc-99m arcitumomab scintigraphy showed increased uptake in the left lateral pelvis indicative of a metastatic focus. Follow-up pelvic MRI and whole-body bone scintigraphy revealed a correlative focal abnormality in the left anterior iliac bone. A CT-guided biopsy of this region revealed metastatic medullary thyroid carcinoma.

Scintigraphy of a double renal transplant from an infant donor.

Renal scintigraphy was performed to rule out a urinary leak on a 47-year-old woman a few days after she underwent pediatric cadaver kidney transplantation. Because of the chronic shortage of donor organs, paired pediatric kidneys (from donors younger than 5 years old) are increasingly transplanted using en bloc extraperitoneal anastomosis of the donor aorta and vena cava into the recipients extemal iliac artery and vein. The transplantation of two infant kidneys into one recipient doubles the amount of functional renal mass and increases the chance of good long-term renal function. The postoperative scintigraphic evaluation did not show any abnormality.

Insidious illness in active seniors: decoding atypical presentations.

Older athletes and active seniors may have serious medical problems without commonly recognized signs and symptoms. The cases of an older tennis player, a golfer, and a deep-sea sport fisherman illustrate unusual presentations of coronary artery disease, bacterial pneumonia, and peptic ulcer disease in senior patients. Alertness for the effects of coexisting illnesses, chronic use of medicines, reduced physiologic and immunologic reserves, altered pain perception, and symptom denial can facilitate prompt treatment of active senior patients.

Acute suppurative epididymal orchitis

Severe epididymal orchitis can deteriorate into testicular necrosis. The authors present the case of a 19-year-old man with acute left testicular pain and no laboratory abnormalities other than a mildly elevated WBC count. Although the scrotal radionuclide scan was consistent with epididymitis, color-flow ultrasound showed no flow to the left testicle and a relatively normal epididymis. An orchiopexy was performed and the patient was placed on antibiotics. One week later, the patient returned with similar symptoms and a left orchiectomy was performed.